Breaking bad news: A communication competency for ophthalmology training programs

Abstract

As the ophthalmology accreditation system undergoes major changes, training programs must evaluate residents in the 6 core competencies, including appropriately communicating bad news. Although the literature is replete with recommendations for breaking bad news across various non-ophthalmology specialties, no formal training programs exist for ophthalmology. There are many valuable lessons to be learned from our non-ophthalmology colleagues regarding this important skill. We examine the historic basis for breaking bad news, explores current recommendations among other specialties, and then evaluate a pilot study to teach breaking bad news to ophthalmology residents. The results of this study are limited by a small number of residents at a single academic center. Future studies from multiple training programs should be conducted to further evaluate the need and efficacy of formal communication skills training in this area, as well as the generalizability of our pilot training program. If validated, this work could serve as a template for future ophthalmology resident training and evaluation in this core competency.

Breaking Bad: An Assessment of Ophthalmologists' Interpersonal Skills and Training on Delivering Bad News

“…8 In another study by Hilkert et al, 34 participants (76%) similarly agreed that ophthalmologists would benefit from a structured approach to training, and 73% felt that residency would be the ideal setting. 9 In our study, a large proportion of physicians, mostly residents, had already received formal training in breaking bad news, and this experience most often occurred during medical school. In contrast, one-third of board-certified ophthalmologists in our study had never attended formal training in breaking bad news.…”

“…In a small pilot study involving 11 ophthalmology residents at a single academic center, residents who were taught how to use the SPIKES protocol to deliver bad news had increased confidence in delivering bad news after the intervention. 9 Larger studies involving more physicians and patients at multiple academic centers are needed to assess the benefit of a formal education plan.…”

“…4 While there are numerous studies on "breaking bad news" in the oncology literature including evaluation of patient's preferences, physician's communication skills, the effect and quality of physician training in delivering bad news, as well as the long-term effects on the patients of the physician's communication skills, [5][6][7] there is very limited literature in ophthalmology related to physician's communication skills when breaking bad news to patients. 8,9 These small studies in ophthalmology have shown that ophthalmologists agree that a formal training program would be beneficial 8,9 and that training may increase the confidence level of ophthalmologists in their ability to deliver bad news. 9 Still, there are no studies to date in ophthalmology which have addressed patient's preferences when receiving bad news, assessed the patient's experience when receiving bad news, evaluated the extent of ophthalmologist training in breaking bad news, or commented on how any of these measures vary with patient demographics (e.g., ethnicity) or physician characteristics (e.g., level of training, practice setting).…”

“…8,9 These small studies in ophthalmology have shown that ophthalmologists agree that a formal training program would be beneficial 8,9 and that training may increase the confidence level of ophthalmologists in their ability to deliver bad news. 9 Still, there are no studies to date in ophthalmology which have addressed patient's preferences when receiving bad news, assessed the patient's experience when receiving bad news, evaluated the extent of ophthalmologist training in breaking bad news, or commented on how any of these measures vary with patient demographics (e.g., ethnicity) or physician characteristics (e.g., level of training, practice setting). Hence, the purpose of the present study is to answer these questions.…”

Delivering Difficult News: Simulation-Enhanced Training Improves Psychiatry Residents' Clinical Communication Skills

“…The SPIKES (11) protocol includes 6 steps: (1) Setting up the environment; (2) assessing the patient's Perception of his/her condition; (3) Inviting the patient to define which information he/she would like to receive; (4) providing the required Knowledge to the patient; (5) addressing the patient's Emotions with empathic responses; and (6) providing a Summary of treatment options and future plans. SPIKES was originally used in oncology but gradually shifted to other fields of medicine, including infectious diseases, gynecology, neurology, and ophthalmology (11,(15)(16)(17)(18). Previous studies have identified the absence of specific guidelines for sharing difficult news in psychiatry (19) and showed the need for such protocols (20), yet the SPIKES model has not yet been empirically studied in psychiatry (21).…”